Hemoglobin Response to 12 Weeks of Iron Supplementation is Substantially Lower among Non‐Pregnant Cambodian Women with Genetic Hemoglobin Disorders
Bibliographic record
Abstract
Objective We measured the effect of 12 wk of oral iron (Fe) with or without multiple micronutrients (MMN) on hemoglobin (Hb) response (Hb increase of ≥10 g/L) among Cambodian women of reproductive age screened as anemic. Methods In this 2×2 factorial double‐blind randomized controlled supplementation trial, 2,846 non‐pregnant women (18–45 y) were convenience sampled from 26 rural villages in Kampong Chhnang province, Cambodia. Those ( n =809) with Hb ≤117 g/L (capillary blood, HemoCue® 301) were randomized to 12 wk of daily oral Fe (60 mg elemental), MMN (14 nutrients excluding Fe), Fe+MMN, or placebo capsules. Results Baseline anemia prevalence (Hb <120 g/L) was 58% ( n =468/808) based on a Sysmex hematology analyzer (venous blood collected 1 wk post HemoCue® screening). Baseline iron deficiency was 25% and 22% based on serum soluble transferrin receptor (>8.3 mg/L) and inflammation‐adjusted ferritin (<15 μg/L), respectively. Overall, 74% of women ( n =596/808) had a genetic Hb disorder (primarily, Hb E variants and α‐thalassemia). Of all women who received Fe (with or without MMN), 25% ( n =95/383) responded with an Hb increase ≥10 g/L at 12 wk; among women confirmed anemic using the Sysmex analyzer, 37% ( n =85/232) responded. Among women with depleted iron stores at baseline (ferritin <15 μg/L) who received Fe (with or without MMN), 67% ( n =57/85) had an Hb response ≥10 g/L at 12 wk. The proportion of women with an Hb increase ≥10 g/L at 12 wk was substantially lower among women with a genetic Hb disorder who received Fe (with or without MMN) (18%, n =53/287), as compared to women with no Hb disorder who received Fe (with or without MMN) (44%, n =42/96). There were no significant differences in the proportions of Hb responders and non‐responders in the MMN and placebo groups, by baseline iron status (iron‐depleted or replete) or by the presence/absence of a genetic Hb disorder. Conclusion The proportion of anemia amenable to iron supplementation among our surveyed population of women (~37%) is at the low end of the 95% CI of the estimate for Southeast Asia (45% [95% CI: 35%, 53%]) as reported in the 2011 WHO Global Prevalence of Anemia Report. The proportion of Hb responders among women with a genetic Hb disorder was substantially lower than among women without an Hb disorder (less than half; 18% vs. 44%, respectively), demonstrating that women with an Hb disorder were much less likely to derive benefit from Fe supplementation. We conclude that it is crucial to understand the multifactorial causes of anemia in each country‐specific setting or population (e.g., the prevalence of Hb disorders) in order to design and implement effective anemia reduction strategies and programs. Support or Funding Information Funding was provided by the Micronutrient Initiative, Sight and Life, and the Canadian Institutes of Health Research (CIHR). C.D.K. received a CIHR Vanier Scholarship, a CIHR Michael Smith Foreign Study Supplement, and a Doctoral Research Award from the International Development Research Centre.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".